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This just came up yesterday in conversation between myself and a urologist. Order a CT abd/pelvis without contrast to check for an obstructing stone. Urology will want that to determine if a stone is causing his hangup. Not sure if the renal US covers the ureters so you could likely be missing the culprit.
Edit: I'm assuming you have a CBC/Chem panel and a UA already.
This just came up yesterday in conversation between myself and a urologist. Order a CT abd/pelvis without contrast to check for an obstructing stone. Urology will want that to determine if a stone is causing his hangup. Not sure if the renal US covers the ureters so you could likely be missing the culprit.Edit: I'm assuming you have a CBC/Chem panel and a UA already.
Yeah CT ABD/Pelvis w/o contrast is almost exclusively used to see anatomy and stones.
I would look to physical anomalies (obstruction of any kind), infected prostate, history of recent regional surgery, kidney or bladder stones, does he live in a nursing home, is he frequently admitted to hospitals, does he chronically use catheters, or is he a diabetic? Does he have a history of renal disease? How has he been treated for the UTIs in the past? What are you seeing in his workups...hematuria, pyuria?...
It sounds like chronic bacterial cystitis or chronic prostatitis. If he's neg for STIs it's probably E-coli. If he's having fever, pain n/v with it you could also work him up for atypical pyelo. Blood cultures might be helpful. I would also r/o HIV.
CT abd w/w/o contrast and a KUB. UA C&S on last UTI. Micro w/reflex if hematuria. Void diary if A&O to do one and possibly bring to appt (depends on doc, some like them some don't care too much). Also, get a PSA, just so urology has a current one.
Urology will probably order a cysto but it's nice to have the other info to see if an invasive procedure is really indicated.
Pachinko
297 Posts
I have a male in his 50s, negative for STI, who keeps getting recurrent UTIs. I'm referring to urology, but I'm not sure whether there are diagnostics I should do prior to the referral. Any suggestions?
Thanks